Council chooses paramedic fee collector
by Cassie Tomlin/ TP staff
Feb 16, 2010 | 12664 views | 91 91 comments | 38 38 recommendations | email to a friend | print
The City Council on Tuesday voted to approve a contract with a company that will later this year bill residents when the fire department responds to medical emergencies and car accidents.

In June, the council decided to charge people when the Tracy Fire Department responds to non-fire incidents within the city limits. Since ambulances aren’t always the first to arrive at the scene of a medical emergency, the city’s fire department goes out on emergency calls, too.

The new fees are a way for the city to make extra money while it suffers a $9 million budget deficit this fiscal year.

On Tuesday, the council approved via a 4-1 vote (with Councilman Steve Abercrombie dissenting) a contract with ADPI-Intermedix, based in Oakland, to send the bills. The city expects to have a billing system ready next month, but doesn’t yet know when it will actually start charging.

Residents will pay $300 for every fire department response to a medical emergency. Non-residents can expect to pay $400. There is no set cost for a fire department visit to a car accident.

The city is working out an option so that households can pay an annual membership fee of $48, which would cover the cost of any emergency aid given during the course of a year, said David Bramell, who is acting as fire chief while Chief Chris Bosch is on administrative leave.

Bramell said ADPI-Intermedix will keep about 15 percent of all the fees the city will charge.

Councilwoman Evelyn Tolbert requested that the city get an update of the program toward the end of this year, at least six months after the city has started charging for the fire department responses. The update will include how much the billing system costs compared to how much the city makes in fees.

Councilwoman Suzanne Tucker said residents are concerned about the new charges because they’re already paying taxes for city services. She said only some insurance companies will pick up the extra costs, and residents are worried how they’ll pay.

Tucker said one person joked if her husband has a heart attack, she’ll be tempted to light the kitchen table on fire to dodge the fees.

Comments
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OrangeSodaPop
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March 02, 2010
Personally, I'm glad the city has the FD respond to these emergencies. The city is resposive to businesses and citizens.

Any contract the county has with an ambulance company only responsive to a number in a contract.

If the amulance company meets a certain "criteria" they don't need to add more ambulances.

The city took that upon themselves to improve this service of medical response times above the criteria listed in the ambulance company's county criteria.

And I think safety SHOULD come first.
jtoo
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March 02, 2010
My earlier post was cut short. The point I was making is that the city is spending a bunch of money on responses that don't actually provide any benefit to the patient except in a small percentage of cases. The city is throwing a lot of resources at something that EMS is mandated to do. Yes, if the city OPERATED the ambulance then they would be collecting money for that response but they would not be able to BILL for the FIRE DEPT response. They would be billing for ambulance service. And whatever revenue they get would have to pay for that service. That $925 is actually one of the lower base rates around. But do you know what is typically collected on that bill (and I am speaking of overall revenue for all services billed by ambulance)? Only about 33%, and yes the rest is written off. A third service ambulance (maybe in the Fire Department, maybe not) is a workable model because you are correct that SOME small part of any money collected would be able to help pay for some of the FIRE response to those calls. But not much. Trimming down on the number of resources sent to certain calls would save a lot more money even if the city was operating the service. I don't believe any of the money that the cities pay to the county actually goes to the ambulance service directly but rather to the EMS Agency that is charged by the state to oversee EMS in the county. That is an expense that wouldn't go away regardless of who operated the service. And, by the way, the city can't just up and start running an ambulance service, they would have to go through a bid process that would cost them about another $75,000 WHEN AMR's contract is up. That is part of the State EMS policy.
mnwild
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February 26, 2010
If the City OPERATED the ambulance service, all EMS responses could be billed to insurance. (The last AMR transport for my husband in October '09 cost $924.34 for Advanced Life Support services and $52.16 for mileage from my house by Poet Christian School to Sutter Tracy Hospital.) As it is, Medicare, Medi-Cal and some private insurers will not pay the cost of Fire Dept. EMS response. This would allow the City to cover the cost of all paramedics, some support personnel, maybe a Fire Chief or two and equipment when it establishes the fees for ambulance response and pretty much be assured it would be paid. Right now if a patient is billed $300 and insurance doesn't pay, it's a matter of getting the $$$$ from the patient -- many on fixed incomes like the elderly and lower income families -- or write the fee off.

The other reason would be to get out from under the County's contract with AMR. I don't know the specifics, except that the County has the contract, all cities pay the County for the service, and cities provide feedback regarding service levels, etc. to the County. From a strictly "service level" perspective, the City running the ambulance service should provide better service to citizens. However, you are talking about approximately $175k per ambulance in start-up costs, hiring the appropriate number of paramedics to staff these ambulances, and the training necessary to service the ambulances, since I doubt any of the City's mechanics has ever worked on an ambulance. I'm sure I'm missing something, but those would be the 3 big cost items.
jtoo
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February 26, 2010
mmwild, I am curious why the city would want to buy the ambulance service? The question is what are you getting for your money (whether taxes or fee's as suggested) from the fire department. As mentioned the FD is not mandated to respond to medical aids, the ambulance is. The truth of the matter is that there are only about 7% of EMS calls that can benefit from a "quicker" response and treatment with more hands (this would assume the FD is ALWAYS ahead of the ambulance, which it is not). In other words you have $300,000 pieces of equipment responding to
Abducted
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February 23, 2010
mnwild -

Here are my thoughts after reading about the budget strapped San Joaquin County, which cannot afford the San Joaquin hospital in Stockton (French Camp), CA:

I wondering if San Joaquin County can afford to keep the ambulance service continuing. I'm thinking it's probably likely that the county ambulance service will get cut at some point in the near future.

I can't say for sure, but it wouldn't surprise me if the county decided to cut the ambulance service in half and start farming the other half out to the fire department in the near future.

Bigger governments seem to be pushing their costs out to smaller governments all across the USA. Just to keep the country afloat.

If that happens then Tracy would be in a better place than many other cities. I'm just glad to hear that you had ample paramedics. Instead of not enough.

mnwild
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February 23, 2010
"Larry Grihalva, emergency medical services coordinator for the Costa Mesa Fire Department and chair of the California State Firefighters Association's EMS committee, said billing for specific service calls is common. 'In a given city, when you pay taxes, what it pays for is the existence and readiness of those services,' he said. He said someone calling for service is an added cost.'

So taxes pay to have a Fire Dept. READY to respond, but NOT to actually respond to medical emergencies. Evidently that COSTS EXTRA. OMG....... Do they make this stuff up as they go along? After this comment there's absolutely nothing else I can say to bring SANITY to this insane situation, so I'm DONE -- except of course for the COMMENT I'll be making on my check every time I send the City of Tracy my $48! (My last great act of defiance!!!!) >;)
Oakmont
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February 22, 2010
All the best 2 you!
Oakmont
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February 22, 2010
mnwild,

I didn't ask anyone or get it in writing. I just did a google search. I will just post what I found online, for you:

"By Sophia Kazmi

Contra Costa Times

Posted: 02/22/2010 06:22:25 PM PST

Updated: 02/22/2010 06:38:46 PM PST

TRACY — City officials are conducting their own emergency response after false reports that Tracy will be charging for all 911 calls.

"I'm really perturbed about it," said City Manager Leon Churchill Jr., who has been answering calls from the media and others from around the country.

Two city council members were contacted by CNN for TV appearances to explain themselves. And the calls, dozens of them — that picked up even more after a New York Times Op-Ed piece about the fee — just keep on coming.

"It's just being mischaracterized so badly." said Churchill.

No one will be charged just for dialing 911. Tracy Mayor Brent Ives faulted poor media reporting that led to the confusion and unnecessary national media attention.

"People want to think it's a 911 fee and it's not," Ives said.

What the Tracy City Council passed last year and plans to start in June is not a 911 fee, said Churchill. No one will be charged for calling the emergency number.

There will be a charge, however, for those who call for and get medical attention from a fire department paramedic — who often arrive on scene before an ambulance.

The fee begins in June and is $300 for residents. Most private insurance will pick up the tab, but Medi-Cal and Medicaid will not, Campbell said. There is no fee if the patient dies.

Residents may subscribe to the service at $48 or $36 a year, depending on income, that covers all

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home medical responses. Businesses can subscribe for $48, covering up to 10 workers. Each extra worker is $3 a year, maxing out at $100.

Churchill said the program is expected to bring in about $500,000 per year.

Tracy, like many cities statewide, is facing financial hard times, Churchill said. Property tax revenue dropped 18 percent in two years.

The City Council had to decide either to kill the fire department's medical services or to keep it going by charging, Mayor Brent Ives said.

As of 2008, about 20 California communities had a similar fee program, Churchill said. Larry Grihalva, emergency medical services coordinator for the Costa Mesa Fire Department and chair of the California State Firefighters Association's EMS committee, ¿said billing for specific service calls is common.

"In a given city, when you pay taxes, what it pays for is the existence and readiness of those services," he said. He said someone calling for service is an added cost.

Grihalva said he has not heard of people not calling 911 because of the fee, but if someone can't breathe, or has some other emergency, they will call, he said.

Staff writer Eric Louie contributed to this story. Contact Sophia Kazmi at 925-847-2122. Follow her at Twitter.com/sophiakazmi.

"
mnwild
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February 22, 2010
Oakmont,

Having 5 paramedics show up during a medical emergency is extremely reassuring (been there, done that), but not at a cost of $300 if I don't subscribe to the $48 annual EMS membership program. During the last EMS call for my husband on 1/27/10, I dealt with 2 paramedics and the rest stood outside the room because there wasn't enough space for everyone. The time before Fire didn't show up, the two AMR paramedics handled the situation perfectly, my husband was transported in a timely manner and received first class treatment from AMR and all hospital staff.

As for insurance companies paying the charges, Sam Sorich, President of the Association of California Insurance Companies, was quoted during an interview on June 8, 2009 saying, "the fact is that many policies do not pay for these fees, and frankly, this does create a difficulty for us insurers when we have to tell our policy holders that these fees are not covered and they're going to have to pay for it themselves." After reading this I phoned Medicare and United Health Care, my primary and secondary coverage and was told they would NOT cover Fire Dept. response charges. The main reason is because AMR is the recognized provider for Advanced Life Support AND transport to the hospital and the Fire Dept. is not.

Regarding your statement, "they only bill you if the FD shows up before the private ambulance company", I've found nothing in all the documents I've read (and I've read every Council staff report, every newspaper article, every page of the consultant's study) that says this. If someone of authority said this, you need to get it in writing, because you'll need it when you get a bill from both AMR and the Fire Dept., especially when they arrive within seconds of each other like they have twice for my husband.

And finally, the question isn't how much is someone's life worth in an emergency?, the real question is what right does the City of Tracy -- or any city -- have to "double bill" those of us who are on a fixed income or implement a "fear tax" because of financial mismanagement? I'll find the $48 annually to pay this "fear tax" and then won't have to worry about how many times I call for EMS, but you can bet when I write that check I will be cussing out those in City government who forced me to do so. I have to manage my personal budget. I saw the handwriting on the wall as the economy started slipping and stopped spending $$$ on non-essential items to insure I could balance my own budget. Why isn't the City of Tracy (or any other city) held to that same standard? I don't have the option of implementing a "tax" on someone else to pay my debts and resent that the City of Tracy (who is supposed to exist to service the citizens of Tracy of which I am one) is doing so and I can't do an darned thing about it!

Oakmont
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February 22, 2010
mnwild,

Each FD shift has more than adequate number of Paramedics to handle emergencies.

http://www.ci.tracy.ca.us/departments/fire/org/

Oakmont
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February 22, 2010
FTUD wrote on Saturday, Feb 20 at 12:19 PM

"Here's a thought. If you tell 9-1-1 dispatch not to send the fire dept but they show up anyway, would you still be charged if you did not use their services by not letting them inside your home. Also, isn't the 9-1-1 emergency service a state requirement since it's mandated by the Federal gov't? If so, the service is already funded so in actuality we're going to be billed twice. If this is incorrect, someone please post. Thanks. "

They only bill you if the FD shows up before the private ambulance company. The FD Paramedics are not mandated. The FD has been providing an ammenity to the city of Tracy that many other cities cannot offer to their citizens and businesses. Improved response times coupled with more Paramedics.

The question you may want to ask is not how much is your insurance, but how much is someone's life worth in an emergency?

Oakmont
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February 22, 2010
sb2482 wrote on Friday, Feb 19 at 01:06 PM

"I'd bet a paycheck my insurance company response to this charge would be something along the lines of telling me I'm a complete moron if I think they will pay this extra fee. "

sb2482 who is your insurance provider?

Oakmont
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February 22, 2010
mnwild It actually is a good idea to keep the FD ambulance service since you get three to five Paramedics showing up. As opposed to only two for the AMR.

And yes, this is becoming a "widespread practice" or moreso than you thought in many other struggling cities around the US, thanks to the Obama administration's lagging economy. There are about 20 cities spread across California alone that alread implement this model, and more to follow. These cities are responding to the call, where Washington DC has failed.

And most private insurance will pay for this service.

billfromtracy,

They are not charging for 911 calls. There are journalists who read the comment sections and ran their story quoting every tomdickandbill from tracy.
mnwild
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February 22, 2010
HiThere,

1. Yes the Tax Assessor values the property, which is the basis for the property taxes paid. A City's General Fund is supported from primarily property tax revenue. The Fire Dept. is funded from the City's General Fund. When property tax revenue is down as a result of a decrease in the value of property there is less money going into the General Fund.

2. The consultant hired by the City to develop this EMS membership fee proposal cited 5 California cities (Costa Mesa, Santa Rosa, Fullerton, Corona and Roseville), Georgetown, TX and Cascade Locks, OR in their comparison of fees and services. They didn't include Reading, PA where our City Manager "cut his teeth" on the type of plan for some reason, but if you check out that City's website and find the Fire Dept., it's very specific on what is charged for which services. If you'd like to read the consultant's report in its entirety, go to the City of Tracy website, find Council Agenda archives. The report was submitted at the May 19, 2009 Council meeting. I warn you it's very long, but when you read the report on each of the cities cited, you'll see that there are different variations to this EMS Fee for Service plan. One city only charges for vehicle accidents while another owns and operates the ambulance service and is reimbursed by most insurance carriers as a result.

2. I'm not an expert on staffing in AMR or the Fire Dept. I can tell you from first-hand experience as recently as January 27, 2009 that a medical response from BOTH AMR and the Fire Dept. results in 5 trained personnel onsite. 2 from AMR and 3 from Fire. I know the AMR staff are all paramedics because I asked, and have been TOLD that all Fire Dept. personnel are paramedics. I don't know this for a fact.

3. If you'd like specifics about how many ambulances are present in the City at any one time or the exact number of paramedics AMR has, you can call them. The number I have for them is in Modesto (800) 913-9106.

4. If you'd like specifics about Fire Dept. personnel numbers and training levels, call the HR Dept. 831-6150.

HiThere
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February 22, 2010
mnwild,

I thought property taxes were adjusted by the County Tax Assessor and not the city?

Besides Redding Pensilvania, which cities have implemented this program?

Where is the list?

How many ambulances does Ambulance company have?

How many Paramedics does Ambulance company have?

How many Paramedics does the Fire Dept. have?

Thanks in advance for posting the infor.

mnwild
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February 22, 2010
Merthurian, check out this link for info. about Reading, PA. http://www.readingpa.gov/fire_rescue.asp.

The main difference between Tracy's program and the one in Reading, PA is the City of Reading , PA operates its own ambulance service. This means most health insurance pays for the Fire Dept. to respond to Emergency Medical Service (EMS) calls. A private ambulance company operates here in Tracy, so medical insurance pays for their EMS response and will NOT pay for Fire Dept. EMS calls. On the one hand, it's nice when 4-5 paramedics (2 from the ambulance company and the rest from the Fire Dept.) arrive during a medical emergency, but the paramedics from the ambulance company are fully qualified to handle EMS calls alone, and at times arrive without the Fire Dept. But the Fire Dept. NEVER responds without the ambulance company because the Fire Dept. can't transport to the hospital. Unfortunately there ARE other cities in the USA that have a similar programs. Those cities were cited by the consultant whose report was used to justify this program in the City of Tracy. Thankfully it is not a widespread practice -- YET! However, as cities look for ways to balance the budget and not raise property taxes, more and more could implement a similar program.

Merthurian
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February 22, 2010
Hi poetryinmotion. I'm from the UK. I wasn't aware that this had already started elsewhere. I can't seem to find out much about the system in Reading.

poetryinmotion
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February 21, 2010
Merthurian are from Reading, PA where they implemented this program if so can you provide some feedback how it works out there in Reading?

Merthurian
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February 21, 2010
Hello people of Tracy! I noticed this story from halfway across the world! Never heard of Tracy, Ca before 10 mins ago! .. If someone asked me to think of a way to kill as many poor people as possible, with the minimum cost, I'd suggest this. And I'd get a promotion for making a profit.
marquise
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February 21, 2010
Txpayer... A responsible and experienced government would never have created a system that unecessarily charges YOU the "Txpayer" for the ambulance and the fire. Unfortunately in the USA, this problem was created years ago and potentially could be solved today. Experience is sometimes bad. A balanced budget would be good and welcomed change we could all agree upon.


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